Table 3 Summary of COM-B themes classified and Barriers and Enablers for health care professionals
COM-B component | Factor | Barrier/enabler | Frequency | Sample Quote |
|---|---|---|---|---|
Psychological Capability | Knowledge and skill | Barrier | 15 | “no support/programmes/resources to support children with physical activity” “no formal qualification. unsure of ability to suggest insulin dose changes” “A lack of training around how to manage blood glucose levels with activity—this is not standard training given to psychologists” |
Complicated guidance | Barrier | 4 | “No explicit guidance is given around the practicalities of what exercise to promote and when and how to review this in a professional capacity” | |
Education | Enabler | 50 | “Better training and local diabetic networks to work on agreed consensus” “National guidance—e.g. flow chart or info sheet to provide to families Making it auditable as to whether it is discussed.” “opportunity to network attend education specific to diabetes, type 1 and CYP” | |
Physical opportunity | Resources | Barrier | 10 | “Making it easier to understand no support/ programmes/ resources to support children with physical activity” “I feel able to offer appropriate advice if they desire it, but if I am seeking to persuade them to increase exercise (i.e. change their behaviour) this requires intensive coaching-style support which we do not have resource to offer.” |
Resources | Enabler | 38 | “Places to signpost children and adolescents to—lots of sites available but not very child focused” “Simplified instructions Electronic resources to direct patients to” | |
Time | Barrier | 37 | “Sometimes there isn't adequate time in clinic.” “Having specific time to spend a long discussion in the clinic setting.” | |
Time | Enabler | 15 | “Time to discuss these issues,” “To acknowledge that this topic is required to be discussed as one of the important factors and one of the basics of the diabetes care. Have available time to support 'fine tuning' of advice.” | |
Social opportunity | Colleague support | Barrier | 6 | “lack of support from colleagues and no formal qualification.” “consistent team approach. support from colleagues and no formal qualification. unsure of ability to suggest insulin dose changes” |
Reflective motivation | Auditing and Tarif payments | Enabler | 5 | “Make this a mandatory part of diabetes care e.g. inclusion of PA measurement and support in the National Paediatric Diabetes Audit.” |